소아청소년기 폐결핵의 방사선상 침범위치에 따른 배양 양성률과 임상양상에 대한 연구 = Clinical Review of Pulmonary Tuberculosis in Teenagers According to the Involved Lung

다국어 초록 (Multilingual Abstract)

Purpose : The purpose of this study was to investigate clinical features and culture-positive rates according to the involved lung in adolescent pulmonary tuberculosis (TB).
Methods : We retrospectively reviewed the medical records of adolescents who ranged in age from 10 to 20 years and who had been hospitalized with a diagnosis of TB at Kwangju Christian Hospital from 2000 to 2008.
Results : Sixty-six patients were identified with pulmonary TB: median age 16.82 years; 48.5% males. Among them, 90.9%of patients were between 15 and 20 years of age. Most patients presented with multiple symptoms, and the most common included cough (74.2%), sputum (60.6%), fever (39.5%), and night sweating (18.2%). Sputum samples were smear-positive in 28 (42.4%), culture-positive in 40 (60.6%), and PCR-positive in 46 (69.7%). The most common radiological patterns included cavitation in 18 (27.3%), pleural effusion in 18 (27.3%), lymphadenopathy in 10 (15.2%), and tuberculoma in 5 (7.6%).
The prevalence of smear, culture, and PCR positive rates increased as the number of involved lobes increased (P <0.05,P <0.01, P <0.05). The median treatment duration was 7 months. Twelve patients (18.2%) had lower lung field TB (Group A) and forty-four patients (66.7%) had other areas involving TB, except for Group A (Group B), and ten patients (15.1%)had only TB pleurisy (Group C). The difference of clinical characteristics and culture rates between group A and group B was not significant.
Conclusion : Pulmonary TB toward late adolescence is increasing. We need to pay more attention to lower lung field TB,which is difficult to detect with specific radiographic findings.

국문 초록 (Abstract)

목 적 : 청소년기 폐결핵의 침범위치에 따른 임상양상및 배양률의 차이에 대해 알아보고자 하였다.
방 법: 2000년부터 2008년까지 광주기독병원에서 폐결핵으로 외래 및 입원치료 했던 10-20세 환자를 대상으로 의무기록지와 흉부방사선 소견을 통한 후향적 조사를 시행하였다.
결 과:총 66명 중 90.9%가 15-20세였고, 평균나이는 16.82세(범위 10-20세)였다. 기침(74.2%), 객담(60.6%), 발열(39.5%) 순으로 많았다. 도말검사 42.4%,배양검사 60.6%, PCR검사 69.7%의 양성률을 보였다.
공동형성이 18명, 가슴막삼출이 18명에서 보였다. 객담도말검사에서 침범엽수가 많을수록 양성률은 통계적으로 의미있게 높았다(P<.05). 치료기간은 평균 7개월이었다. 하폐야 결핵 12명(A군), A군을 제외한 폐병변이있는 44명(B군), 결핵 가슴막염만 있는 10명(C군)으로구분하였으며, 각 군간의 임상양상 및 배양 양성률의 차이는 통계적인 유의성은 없었다.
결 론 : 청소년기 후반으로 갈수록 폐결핵이 증가하고,폐결핵의 특징적인 방사선 소견으로 진단하기 어려운 하폐야 결핵에 대한 관심이 필요하겠다.

참고문헌 (Reference)

• 1 Strake JR, "Tuberculosis, In: Nelson Textbook of Pediatrics. 18th ed" Saunder Co 1240-1254, 2007
• 2 Ossen EZ, "Tuberculosis of the lower lobe" 230 : 693-, 1944
• 3 Inselman LS, "Tuberculosis in children: an update" 21 : 101-120, 1996
• 4 Lobato MN, "Tuberculosis in children and adolescents: California, 1985 to 1995" 17 : 407-, 1998
• 5 Starke JR, "Tuberculosis in children" 7 : 268-277, 1995
• 6 de Pontual L, "Tuberculosis in adolescents: A French retrospective study of 52 cases" 25 : 930-, 2006
• 7 Wilcox WD, "Tuberculosis in adolescents. A case commentary" 33 : 258-262, 1994
• 8 Lincoln EM, "The value of follow-up studies of children with primary tuberculosis" 64 : 499-507, 1951
• 9 Steele JD, "The solitary pulmonary nodule. Report of a cooperative study of resected asymptomatic solitary pulmonary nodules in males" 46 : 21-, 1963
• 10 Marais BJ, "The natural history of childhood intra-thoracic tuberculosis:a critical review of literature from the pre-chemotherapy era [State of the Art]" 8 : 392-402, 2004
• 11 Nong BR, "Ten-year experience of children with tuberculosis in southern Taiwan" 42 : 516-520, 2009
• 12 Nemir RL, "Teichner A. Management of tuberculin reactors in children and adolescents previously vaccinated with BCG" 2 : 446-451, 1983
• 13 McAdams HP, "Radiologic manifestations of pulmonary tuberculosis" 33 : 655-, 1995
• 14 Rothstein E, "Pumonary tuberculosis involving the lower lobes" 59 : 39-, 1949
• 15 Nemir RL, "Perspectives in Adolescent Tuberculosis: Three Decades of Experience" 78 : 399-, 1986
• 16 Trulson MF, "Nutritional Studies in Adolescent Girls and Their Relation to Tuberculosis" 44 : 689-, 1954
• 17 Berger HW, "Lower lung field tuberculosis" 65 : 522-, 1974
• 18 Segarra F, "Lower lung field tuberculosis" 87 : 37-40, 1963
• 19 Chang SC, "Lower lung field tuberculosis" 91 : 230-232, 1987
• 20 Lee JJ, "High resolution chest CT in patients with pulmonary tuberculosis: Characteristic findings before and after antituberculous therapy" 67 : 100-104, 2008
• 21 Sreeramareddy CT, "Clinico-epidemiological profile and diagnostic procedures of pediatric tuberculosis in a tertiary care hospital of western Nepal-a case-series analysis" 10 : 57-, 2010
• 22 Yang CK, "Clinical studies on lower lung field tuberculosis" 9 : 186-, 1976
• 23 Aktogu S, "Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases" 9 : 2031-2035, 1996
• 24 Silvestre J, "Clinical predictors of infectious pulmonary tuberculosis" 23 : 625-630, 2010
• 25 Ahn DS, "Clinical observation of lower lung field tuberculosis" 9 : 757-, 1976
• 26 Ayatollahi J, "Clinical Study of Lower-Lung Field Tuberculosis" 31 : 79-81, 2006
• 27 Ki Man Lee, "Clinical Investigation of Cavitary Tuberculosis and Tuberculous Pneumonia" 대한내과학회 21 (21): 230-235, 2006
• 28 Marais BJ, "Childhood pulmonary tuberculosis: old wisdom and new challenges" 173 : 1078-, 2006
• 29 Kam A, "Active tuberculosis among adolescents in Toronto, Canada: Clinical features and delays in diagnosis" 26 : 355-, 2007
• 30 Sohn HY, "A clinical study on the lower lung field tuberculosis" 32 : 86-92, 1985
• 31 KCDCP, Korean Institute of Tuberculosis KNTA, "2007 Annual report on the notified tuberculosis patient in Korea (based on tuberculosis surveillance system)"